Details

Autor(en) / Beteiligte

• Khattar, Nicolas K.
• Koutourousiou, Maria
• Fernandez-Miranda, Juan C.
• Wang, Eric W.
• Snyderman, Carl H.
• Cohen-Gadol, Aaron A.
• Gardner, Paul A.

Titel

Endoscopic Endonasal and Transcranial Surgery for Microsurgical Resection of Ventral Foramen Magnum Meningiomas

Ist Teil von

• Journal of Neurological Surgery Part B: Skull Base, 2015, Vol.76 (S 01)

Erscheinungsjahr

2015

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Introduction: Purely ventral foramen magnum meningiomas are challenging tumors to treat given their location, proximity and relationship to the brain stem, lower cranial nerves, and vertebral arteries. Endoscopic endonasal surgery (EES) presents an alternative to the traditional far lateral suboccipital approach (FLA) but comparisons are limited given the rarity of this pathology. Methods: From May 2008 to October 2013, five patients underwent EES and three patients underwent a FLA surgery for primary ventral foramen magnum meningiomas. We retrospectively reviewed their records to evaluate outcomes. Results: Of the eight patients, six presented with long-tract and lower cranial nerves deficits. Gross or near-total resection was achieved in every case using either approach. Preoperative median Karnofsky score was 80 (range, 40–100), which improved to 100 postoperatively (range, 90–100) in both the transcranial and the endoscopic groups. In the patients who had EES, preexisting deficits included long-tract signs as well as dysphagia, which improved in every patient. All preexisting deficits (long-tract signs only) improved in the patients who had the transcranial FLA. Following EES, one patient (20%) developed CSF leak that resulted in meningitis and one patient developed an epidural abscess following necrosis of the nasoseptal flap, which required debridement. The latter patient was one of two patients who developed hydrocephalus after EES requiring ventriculoperitoneal shunt insertion without sequelae. In the FLA group, one patient developed a pseudomeningocele and required insertion of a ventriculoperitoneal shunt. The two EES patients with hydrocephalus developed deep venous thrombosis after EES, which resulted in a pulmonary embolism in one of them; they were managed with anticoagulation without further sequelae. No patient developed occipitocervical instability following EES or FLA. There were no new lower cranial neuropathies or operative mortality in either group. Conclusion: Both EES and FLA provide excellent results for resection of ventral foramen magnum meningiomas. EES may have more reconstruction-related complications.